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Biomedical subjects

J F Fries

Publications and source records attributed to J F Fries.

At least 109 records · Page 6Linked to original sources
PubMed1992

Health habits, health care use and costs in a sample of retirees.

Relationships between health habits and subsequent medical costs were analyzed for a group of 1,558 Bank of America retirees followed for 12 months. Results suggest that absence of cigarette smoking, excessive drinking, and excess body mass, and increased exercise and seat belt use were associated with roughly $372 to $598 of direct costs savings and $4,298 of total costs savings per person per year. This study presents what appears to be the first longitudinal data relating health habits to health costs in a senior sample.

Aged↗
PubMed1992

Randomized controlled study of a retiree health promotion program. The Bank of American Study.

The initial results of a 12-month controlled trial of a health promotion program in 5686 Bank of America retirees, randomized into full program, questionnaire only, and insurance claims only groups, were analyzed to determine whether the health promotion program was effective. Comparisons were between program and questionnaire only groups for self-reported health habit changes, health risk scores, medical care utilization, and days confined to home, and between all groups for insurance claims data. The intervention, or full program, included health habit questionnaires administered every 6 months, individualized time-oriented health risk appraisals, personal recommendation letters, self-management materials, and a health promotion book. Twelve-month changes in health habits, health status, and economic variables favored the full program group in 31 of 32 comparisons and were statistically significant at the .05 level in two-tailed tests in 19 comparisons and at the .01 level in two-tailed tests in 13 comparisons. Over 12 months, overall computed health risk scores decreased by 4.3% in the full program experimental group and increased by 7.2% in the questionnaire only control group. Total direct and indirect costs decreased by 11% in the experimental group and increased by 6.3% in the questionnaire only control group. Analysis of claims data confirmed these trends. A low-cost health promotion program for retirees was effective in changing health behaviors and has potential to decrease health care utilization.

Aged↗
PubMed1991

Occupation, income, and education as independent covariates of arthritis in four national probability samples.

The strong associations between education level and prevalence and severity of arthritis have recently been investigated, with some suggestion that the relationships might be causal. Data from 4 national probability samples were analyzed, in which occupation and income were measured currently and prior to the development of arthritis. These data indicate that previous studies overestimated the strength of the association between schooling and arthritis because income and, especially, occupation were not analyzed as separate covariates. The overestimate appears to be especially high for persons currently employed, for men, and for persons employed in dangerous jobs. Health policy strategies directed toward reducing arthritis rates require not simply a focus on education, but the additional socioeconomic status dimensions of income and occupational safety and health.

Arthritis↗
PubMed1991

The relative toxicity of nonsteroidal antiinflammatory drugs.

Toxicity Index scores were computed from symptoms, laboratory abnormalities, and hospitalizations attributed to nonsteroidal antiinflammatory drug (NSAID) therapy in 2,747 patients with rheumatoid arthritis receiving 5,642 courses of 11 NSAIDs over 8,481 patient-years. Substantial differences in overall toxicity were found, the differences between drugs often being clinically significant (2-3 times as toxic) and highly statistically significant. The results strengthened after adjustment for differing patient characteristics, held generally across multiple ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) data bank centers, and persisted after use of different techniques for the weighting of side effects. The most toxic side effects were experienced by patients taking indomethacin (mean +/- SEM score 3.99 +/- 0.58), tolmetin sodium (3.96 +/- 0.74), and meclofenamate sodium (3.86 +/- 0.66). Least toxic were coated or buffered aspirin (1.19 +/- 0.10), salsalate (1.28 +/- 0.34), and ibuprofen (1.94 +/- 0.43). The most toxic drugs were generally taken in the lowest relative doses. There are statistical differences in overall toxicity between different NSAIDs as used in rheumatoid arthritis, and these differences are both clinically and statistically significant.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models.

PURPOSE: The most prevalent serious drug toxicity in the United States is increasingly recognized as gastrointestinal (GI) pathology associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The incidence of serious GI events (hospitalization or death) associated with NSAID use was therefore prospectively analyzed in patients with rheumatoid arthritis (RA) and patients with osteoarthritis. PATIENTS, METHODS, AND RESULTS: The study consisted of 2,747 patients with RA and 1,091 patients with osteoarthritis. The yearly hospitalization incidence during NSAID treatment was 1.58% in RA patients and was similar in all five populations studied. The hazard ratio of patients taking NSAIDs to those not taking NSAIDs was 5.2. The incidence in osteoarthritis may be less. The risk of GI-related death in RA patients was 0.19% per year with NSAIDs. Multivariate analyses assessing risk factors for serious GI events were performed in the 1,694 (98 with an event) RA patients taking NSAIDs at the predictive visit. The main risk factors were higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, level of disability, and NSAID dose. A rule is presented that allows estimation of the risk for the individual patient with RA. CONCLUSION: Knowledge of the risk factors for NSAID-associated gastropathy and their inter-relationships provides a tool for identification of the patient at high risk and for initiation of appropriate therapeutic action.

Adult↗
PubMed1991

Variables associated with decreased survival in systemic lupus erythematosus.

Fifty-one deaths occurred among 310 patients with systemic lupus erythematosus (SLE) observed for 1,234 patient-years. Twenty-one of 97 entry variables at first clinic visit were associated with an increased risk of mortality. When corrected for multiple comparisons, the only risk factor that retained statistical significance was systolic blood pressure. Each millimeter unit increase in systolic blood pressure corresponded to a 2% increase in mortality risk. Stepwise covariance and recursive partitioning analyses tended to identify nonspecific prognostic variables, rather than the classic serological and diagnostic features of SLE. These data suggest that hypertension is a more significant risk factor for mortality in SLE than the more specific measures of disease severity.

Actuarial Analysis↗
PubMed1991

The hierarchy of quality-of-life assessment, the Health Assessment Questionnaire (HAQ), and issues mandating development of a toxicity index.

Health, as defined by the World Health Organization, encompasses the more redundant and cumbersome phrase "health-related quality of life." Valuations by patients naturally separate this entity into the primary dimensions of absence of death, disability, discomfort, drug toxicity, and destitution. These dimensions separate naturally into subdimensions, and the subdimensions into components, thus providing a hierarchy under which assessment of particular aspects of health may be placed. In the clinical trial situation, it is essential that all dimensions always be assessed and reported, because otherwise, misleading conclusions may be drawn. On the other hand, it is much less important which assessment instrument is chosen, or how much detail is assessed for each dimension. The Health Assessment Questionnaire (HAQ) has been developed under a hierarchical conceptual model and widely used; its characteristics are described. A new index for measurement of drug toxicity has been developed for the HAQ, and its crucial role in comparing treatments in a clinical trial discussed. Issues in reliably describing comparative drug toxicity are developed, a toxicity index presented, and some preliminary results and conclusions outlined. With the ability to quantitatively describe drug toxicity, health assessment becomes conceptually more complete.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1991

Effect of changes in weight-bearing exercise on lumbar bone mass after age fifty.

This two year longitudinal study of 40 healthy subjects over age fifty (27 exercisers, 13 non-exercisers) was designed to evaluate the impact of weight-bearing exercise on lumbar bone mineral density as assessed by quantitative computed tomography. In both males and females exercising at moderate levels, a high correlation was found between changes in exercise and changes in bone density (r = 0.78 and 0.91, respectively P less than 0.002). For extreme levels of exercise (greater than 300 min/week in females over age fifty, and greater than 200 min/week in males over age seventy) bone density was low, confirming earlier cross-sectional results. Subjects without change in their exercise levels and non-exercisers lost similar amounts of bone. Increasing body mass index was identified as a protective factor with regard to lumbar bone loss. We conclude that in exercisers continuation of weight-bearing exercise is mandatory to prevent excessive bone loss. Extreme levels of exercise may be detrimental to bone density in subjects over age fifty years.

Bone Density↗
PubMed1991

Toxicity profiles of disease modifying antirheumatic drugs in rheumatoid arthritis.

The toxicity profiles of 7 disease modifying antirheumatic drugs (DMARD) (hydroxychloroquine, intramuscular (im) gold, D-penicillamine, oral gold, methotrexate (MTX), azathioprine and cyclophosphamide) were evaluated in 2,479 patients with rheumatoid arthritis consecutively enrolled at 5 centers in the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) program. Incidence rates for side effects are reported as events/1000 patient-years. Our descriptive study revealed an individual profile of prevalent toxicities for each drug. Oral gold was characterized by substantial lower gastrointestinal (GI) toxicity (diarrhea 391 events/1000 patient-years, loose bowel movement 148, lower abdominal pain 76), MTX by hepatotoxicity (47) while D-penicillamine had the only clinically significant incidence of altered taste (40). MTX users reported the most mucosal ulcers (87), followed by oral gold (76), im gold (55) and D-penicillamine (38). Rash was frequently seen with gold compounds and D-penicillamine, while upper GI toxicity was common with immunosuppressive agents. Cyclophosphamide had 48% discontinuations within 6 months. MTX had the lowest discontinuation rate in the first 6 months, but then showed little difference from im gold. A preliminary similarity index was developed to compare the toxicity profiles of various DMARD. Close similarities were found between toxicity profiles of im gold and D-penicillamine, and between azathioprine and MTX. Oral gold had a unique toxicity pattern. Knowledge of these different toxicity patterns can enable more appropriate selection of agents for particular patients.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Mortality predictors among 263 patients with rheumatoid arthritis.

A cohort of 263 patients who completed Health Assessment Questionnaires (HAQ) each year from 1981 to 1989 is examined. Forty-three (43) possible covariates measured in 1981 are considered that might help predict mortality over the 8 years of the study. We use univariate correlation coefficients, stepwise regressions, and survival functions to identify a number of covariates that appear useful for predicting survival: age (-), prednisone use (-), disability index (-), male sex (-), never married (-), penicillamine use (+), divorced (+), and no occupation (-). Our results confirm studies suggesting that the HAQ disability index is a useful prognosticator of length of survival.

Adult↗
PubMed1991

Predictors of fractures in early rheumatoid arthritis.

Three hundred ninety-five patients with rheumatoid arthritis (mean age 49 years) were followed for an average of 6.7 years, and their baseline variables from the initial visit were examined for prediction of time to first fracture. Multivariate analyses identified use of corticosteroids in women and prior diagnosis of osteoporosis as important risk factors. Among patients taking 5 mg or more of prednisone, female sex strongly predicted fractures: the 5-year probability of having a fracture was 34%. Low risk groups were nonosteoporotic and consisted of men and patients taking less than 5 mg prednisone.

Adolescent↗
PubMed1991

Education level and rheumatoid arthritis: evidence from five data centers.

Data on 2,006 patients with rheumatoid arthritis (RA) for 1984 and 1986 were analyzed from 5 American Rheumatism Association Medical Information Systems patient centers to assess covariates of future disability. The dependent variable was the Health Assessment Questionnaire disability index, measured in 1986. Independent variables, measured in 1984, include years of schooling, age, age squared, sex, labor force status, occupation, marital status, race, income, sedimentation rate, log latex, number of tender joints, and duration of illness. A negative association between schooling and the disability index is strongly apparent for men and weaker in women. Results for men persist even after adjustment for occupation and income, but not after additional adjustment for biological variables. The effects of schooling upon progression of RA are complex and interpretation requires simultaneous assessment of a variety of other variables. Causal effects of level of schooling are seen with a social science perspective which considers the biologic data to represent dependent variables yet cannot be inferred from a clinical model which considers the biology of the disease as an independent variable.

Arthritis, Rheumatoid↗
PubMed1991

NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal.

Nonsteroidal antiinflammatory drug (NSAID) gastrointestinal (GI) pathology (gastropathy) accounts for over 70,000 hospitalizations and over 7,000 deaths annually in the United States. Not all patients, however, are at equal risk. Major risk factors for serious events (hospitalization or death) in patients with rheumatoid arthritis (RA) are age, level of disability, concurrent use of prednisone, prior NSAID side effects and NSAID dose. For the average patient with RA, the chance of hospitalization or death due to a GI event is about 1.3 to 1.6% over the course of 12 months and about 1 in 3 over the entire course of the disease. Subgroups of patients have risks ranging from nearly zero to as high as 4 or 5%/years. A simple scoring system based on multivariate analysis of risk factors permits the clinician to directly calculate the risk for the individual patient.

Age Factors↗